ENC2010-00076,iun. 2. 2010 9,07AM
No. 2415 P. 1
CITY OR CAMPBELL ENCROACkTM$NT pl31ZMIT Permit No ~N C ` a if.~- CX:l~7lcl
>7$PT. OF PCJ$LIC WOIZICS (for working within the public X-Ref. File __
70 North First St. right-of--way)
Campbell, CA 95flOS Application Date ~r~ ~~~~
(a08) 866-2150 Issued ~ L~ I ~ 6 Applic~tion~~E--ttyypi""ration Date~a,~~i(~~''
Pao (408} 376-0958 (:., ~{ ~ ~ ApN ~\l,5~~ .~
Permit Pxpiration Date
ApPLCCATION -Application is hereby made for a Public'UVorks Permit in accordance with Campbell Municipal Code, Section l L04. (Application axpires.in six (b)
months if the pcrrrtit is not issued. (A~pplieati~n Fee is non-refundable.)
A. Work address or tract #~,,, -I ~ ~ ~~ ~'~d ~~ - -
Utility trench location *~
B. Nature of work
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C. Attach four (4) copies of en en~neercd plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's fistimate of work. The
plans shall show the relation of the proposed work to existing surface end underground improvements. 1~Jhen approved by the City Engineer, sflid plan becomes a
pazt of this permit.
D. Ali work shall conform to the City of Campbell Standard Specifications and Details for Public Works Consauetion; the General Permit Conditions listed on the
rcacrsc side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture
of E+aithtlrl Performance Sureties and cash deposits, (See General permit Conditions 1 and 2.)
E. The Contractor must have this parrnit and approved plans at the site and must notify the Public Works 1]epartment at least two days before starting work. Notice
must be given to Public Wor/k~s at least 24 hours before restatling any work.
Name of Applican t~ i .Telephone ~~~ ~~ ~°~~~
/~ ~j (print ~,,~y~ ~~~,, ~~~
Address ~~ ~t~~ ! I • 1./ _ ~ 24-HOUR EMERG$NCY TELEPHONE N0. ~ y ~•~'~ y~
8-Mail Address I ~ ! /~ c ~'~~ ~
Is this work being done by the property owners at their own residcnco? Yes ~ No
The ApplicantlPerm~ ttcc hereby agrees by affixing their signature to this permit to hold the City of Campbdl, its officers, agents and employees free. sate and hflrmlcss
from any claim or domand for flamages resulting from the work covered by this permit,
The ApplicanUPermi[tee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the
information. Applicant is advised that upon issuance of this pcrrrtit, property owner, or property owner's suceessors,'ahall be responsible For any and elf damages
arising out of the condition of a rmprovamems t he b ri -
(sign)
Convector (Print Name)
Date
Data
Sp1CIAL PCiOVIS10NS
_t . 5tree[ shall not be open cut for underground installations. Minimum cuts.m~a he allowed for connections or axploraeion holes. Such cuts mks
csR~ifjfal-v a~araved by the lnspeolor arior to cutting. '
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_2. Pavement may be cur far underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A^, unless otherwise approved by Inspector.
~. Work to be staked by a licensed land Surveyor or Civil Engineer and two (2) copies of the cur sheets sent to the public Works l7epartment
before surrting work-
_4. I'cr Section 42J S of the (3ovemment Code this permit is not valid Far excavations until Underground Service Alert (USA) has been notified and T
C ` 1 ' 1
the inquiry identification number has been ontared hereon. 1lSA phone I-800-227-2600. USA TICICI3T NO. ~ C ^
Z
`~ 5. Prior to any work, the property'owncr shall execute an Agreement for Private Improvements in the public Rigttt-of-GVay, which shall be ~
_
recorded. O o I , 1
_ti, Public Notification Requirements: ~ tv
O ~~
5EE PUBLIC WORKS FEE 5C}IBDULL ~R CUR1tBNT FEE& AMOUNT RECEIPT N0. ~ v
3 ~ 5
p13RMI7` ApPLI~ATION FEE $
FLAN CHECK DEPOSIT ~
SECURITY FOR FAITHFUL P13RxORMANCE/LABOR ~ lvIATERIALS $ --
CONS? RUCrT4N CASY-T 61dpOSiT ~
PLAN CC4ECK & INSPECTION FEB ' $~
~ / ~ ~ ~~
AFPRO\rED FOR iSSUANC$
i~or City Engin ~ 1~atc
Permit Ex Tres 12 Months ttcr Date of Issuance
,~ ~.agr-~-~~ ~~ is .
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!.~~~. 2. 2011} 9;07AM
Gi1iV~~AL FERMIT CO1~DX'~IONS
No. 241 ~ P. 2
L. A Construction Cash r]eposit is required. Charges will be made against this deposit if there is an emergency call~oue, ovcrtimt inspection or when City
ordered barricading is required. Any such costa in excess of the deposit will be billed to the Pormitree.
2. A onc•ycar maintenance period and surety are required. Such period will begin on date of written acceptance by the City.
3- Refund of the cash deposit balance and refund or cancellation of the faithful Performance Surety will be initiated by the written accepmnce of the work
6y the City.
4. The Permittee must request itt writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to
the Permittu.
5. Maintain safe pedesuian end vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves.
6. A Construction Traffic Canwl Plan and a Construction Schedule arc required far all lane closutcs, detours end atrect closures. This plan must be
reviewed and approved prior [o any Lane closures.
7. The Construction Traffic Control Ptan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance 'Work Zones, dated
1990ravailable at Cahrans. Traffte control equipment shalt include Type II flashing arrow signs if required.
S. Replace as dlreetcd by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole
expense of the Perntittee.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest seorcmark and shall be doweled to existing improvements.
10. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of
inspection costs at the current overtime raft.
t t. Adequate signing and barricading is required on the job sire. failure to provide such signing and barricading may rosull in the City's providing signing
and barricades and charging the cost (including all labor and materials) against [he cash deposit
12. Compaction testing of subgrade, base rock, and asphalt concrete by Pcrmittee is required unless otherwise staled by the City engineer.
13, The Contractor or Petmittcc will have a supervisory representative available for contact on the project at all times flaring canslmction. Contractor or
Permittcc shall provide a phone number atwhich /hey can be contacted outsifle the hours of 8;00 a.m. to 4:Q0 p.m.
14. Na smragc of tnaterials or equipment will be allowed ntar the edge of pavement, the traveled way, or within the shoulderline which would create a
hazardous condition to the public, ,
15. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a
separate permit may be required, nor does it relieve the Permiuee of any obligation to obtain any other permit required bylaw.
1b. This permit does no[ release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
17. This permit is not transferable. Work must be performed by the Pernnittce or his designated agent or contractor as apeciFied therwn,
l4. Colt back (call out) due to emergencies regarding this permit shall be at [he current overtime rare with a three (3) hour minimum charge per occuttenee.
[ 9. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system
other than storm water. Applicant shall aflhcrc to the BEST MANAGEMENT PRACf1C$S established by the Sanut Clara Valley Urban Runoff
Pollution Prevention program.
2Q 1F the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve
any modification or departure and to specify the manner in which the same is to be made far Cily~owned or maintained facilities.
23. Permiuce must provide advance notification to all parties that may be affected by the permit activities, Notification shall ba reviewed by Cary prior to
'distribution and include dates of work and a contact name and phone number.
applicant shall be responsible for ensuring that all those providing services under the applicant arc aware of and understand all of the above conditions.
Aatc
>7ate
7~formclpwpcrm
Rev. 1119/05.
Contractor (Print l~amo)
~~un, 2. 2010 9.08AM
Pael}Ic Gas and ~IgCtriC Company
Field Paving Measurem®nts
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ORDER NUMBER
ORDER pESCRIPTION
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PRbJECT TITLE
No, 2415 P. 3
page 1 of
PREPARED BY
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DATE PREPARED
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